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margin-top: 38px; Reduction mammoplasty improves symptoms of macromastia. 1999;103(1):76-82; discussion 83-85. Plast Reconstr Surg. Tobacco use was shown to have a higher rate of reoperation (p= 0.02) and BMI was identified as an independent risk factor for wound complications (odds ratio, 1.85, P = 0.005). Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for of the following criteria must be met: Another set of breast pump supplies if you get pregnant . } 2008;61(5):493-502. #backTop:hover { 1993;91(7):1270-1276. Because of their inherently subjective nature, pain symptoms are especially prone to placebo effects. Aesthetic Plast Surg. 2017;35:157-161. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. 2019;166(5):934-939. Reduction mammoplasty for asymptomatic members is considered cosmetic. The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 %)]. The Mammotome procedure represented another novel therapeutic option for gynecomastia. The data were retrospectively analyzed for demographics, operative and histopathology reports, oncological treatment, and post-operative follow-up. Krieger LM, Lesavoy MA. Plastic Reconstr Surg. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. OL OL OL OL OL LI { The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. Surgical removal is rarely indicated and the vast majority of the time is for cosmetic reasons, as there is no functional impairment associated with this disorder. Mistry and associates (2017) examined outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. Kasielska-Trojan A, Danilewicz M, Antoszewski B. background-position: right 65%; The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. Surgical treatment of primary gynecomastia in children and adolescents. Tang CL, Brown MH, Levine R, et al. However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. Early complications were rare (6.1%), with superficial skin and soft tissue infections accounting for 45.8% of complications. A cohort study of breast cancer risk in breast reduction patients. For individuals who received radiation treatment to the chest . ER expression did not correlate with the right (p = 0.51) and left 2D: 4D (p = 0.97). skin should not be excised horizontally below the inframammary fold. He Q, Zheng L, Zhuang D, et al. Klinefelters syndrome, testicular, adrenal, or pituitary tumors, and thyroid or hepatic dysfunction are also associated with gynecomastia. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Mizgala CL, MacKenzie KM. Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Women's Health and Cancer Rights Act of 1998. The average age was 24.7 years (range of 18 to 47 years). Orthopedic or spine surgeon evaluation of spinal pain; Radiotherapy (for the prevention or management of gynecomastia recurrence); Vacuum-assisted breast biopsy system for treament of gynecomastia. The authors reach the remarkable conclusion that a woman with normal sized breasts who has only a few ounces of breast tissue removed is as likely to receive as much benefit from breast reduction surgery as a women with large breasts who has substantially more breast tissue removed. color: white; A systematic search of the published literature was performed. Reduction mammaplasty: Defining medical necessity. ul.ur li{ Am Surg. Med Decis Making. However, these medications should be reserved for those with no decrease in breast size after 2 years. In this study the National Surgical Quality Improvement Program data set was queried for the Current Procedural Terminology code 19318 from the years 2005 to 2010, with principal outcome measurements of wound complications, surgical site infections, and reoperations. Reduction mammaplasty: An outcome study. Patients in vacuum-assisted breast biopsy group had a better cosmetic outcome than those in open surgery group. Sixteen (23%) patients had complications and higher resection weight, increased BMI, and older age were found to have statistically significant complication rates with p-values of p<0.001, p=0.034, and p=0.004, respectively.The investigators also found that the incidence of complications was highest among current smokers and lowest among those who had never smoked with a 37% difference in the occurrence of complication (p<0.01). Three review authors undertook independent screening of the search results. A retrospective study of changes in physical symptoms and body image after reduction mammaplasty. Laituri CA, Garey CL, Ostlie DJ, et al. Computed tomography scan of adrenal glands to identify adrenal lesions. Kasielska A, Antoszewski B. Surgical management of gynecomastia: An outcome analysis. Aetna has their own sliding scale which requires more from smaller patients relative to the Schnur scale, but maxes out at 1000 gms per breast. The Breast: Comprehensive Management of Benign and Malignant Diseases. 2010;125(5):1301-1308. bottom: 20px; Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Reduction mammoplasty: Criteria for insurance coverage. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Asian J Surg. Morbidly obese patients are at the highest risk, with complications occurring in nearly 12% of this cohort. 40 . World J Surg. Sood R, Mount DL, Coleman JJ 3rd, et al. Plastic Reconstr Surg. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. A total of 90 patients underwent breast re-reduction surgery. The characteristics of patients as well as the curative effects between the 2 groups were analyzed. Arch Dis Child. Ann Plastic Surg. Mayo Clin Proc. Administration of Benefits and Transition Responsibilities border: none; Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. In the case of reduction mammoplasty for relief of back, neck and shoulder pain, Aetna has considered this procedure medically necessary in women with excessively large breasts because it seems logical, even in the absence of firm clinical trial evidence, that this excessive weight would contribute to back and shoulder pain, and that removal of this excessive breast tissue would provide substantial pain relief, reductions in disability, and improvements in function. A non-standardized survey showed a very high satisfaction index. If reduction mammoplasty was performed before oncological treatment, the incidence of abnormal findings was higher. A total of 244 out of 1,628 patients with the average age of 23.13 years. Nguyen JT, Wheatley MJ, Schnur PL, et al. Qu S, Zhang W, Li S, et al. Plast Reconstr Surg. The authors concluded that gynecomastia treatment combining high-definition liposculpture to male breast tissue resection via a new, almost invisible incision allowed these researchers to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications. Gynecomastia: Evolving paradigm of management and comparison of techniques. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. # color: white; Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The risks included infection, wound breakdown, scarring, and the need for re-operating. Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. Variations in pattern of pubertal changes in girls. Endocrinol Metab Clin North Am. Often times, insurance company will dictate how much breast tissue to be removed. ASPS clinical practice guideline summary on reduction mammaplasty. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. .arrowPurpleSmall, a:hover.arrowPurpleSmall { Hello! 1991;27(3):232-237. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. 2005;58(3):286-289. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Drugs commonly associated with the development of gynecomastia include amphetamines, marijuana, mebrobamate, opiates, amitriptyline, chlordiazepoxide, chlorpromazine, cimetidine, diazepam, digoxin, fluphenazine, haloperidol, imipramine, isoniazid, mesoridazine, methyldopa, perphenazine, phenothiazines, reserpine, spironolactone, thiethylperazine, tricyclic antidepressants, tirfluoperazine, trimeparazine, busulfan, vincristine, tamoxifen, , methyltestosterone, human chorionic gonadotropins, and estrogens. Breast pumps. border-width:0; These researchers compared the safety and effectiveness of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. Liposuction facilitated the easy handling to remove the breast tissue via small incisional design; showed consistent improved QOL in terms of satisfaction after surgery. Evidence-based clinical practice guideline: Reduction mammaplasty. Drainage in breast reduction surgery: A prospective randomised intra-patient trail. breast augmentation with implant. GP Notebook. And if you are in Canada the surgeon decides. The authors concluded that small incisional design for breast parenchymal removal in gynecomastia assisted by liposuction showed a good technical approach for consistent improvement in QOL; however, only 2 studies reported good quality methods of non-randomized case-series urging for a better quality of studies in the future. Beer GM, Kompatscher P, Hergan K. Diagnosis of breast tumors after breast reduction. Mannu and colleagues (2018) stated that idiopathic gynecomastia is a benign breast disorder characterized by over-development of male breast tissue. Following treatment, 90.1 % (n = 73) had a complete response of their gynecomastia with tamoxifen therapy. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an out-patient; however, this was not statistically significant (p = 0.07). Gynecomastia surgery is the surgical correction of over-developed or enlarged breasts in men. A physician-supervised diet and exercise plan may be indicated in obese patients. Plast Reconstr Surg. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). In a systematic review, Prasetyono and colleagues (2021) examined the quality of studies and re-visited liposuction-assisted gynecomastia surgery performed via minimal incision. There are alsoseveral earlier, smaller studies that found reductions in symptoms and improvements in quality of life after reduction mammoplasty (Glatt et al, 1999; Bruhlmannand Tschopp, 1998; Blomqvist et al, 2000; and Behmand et al, 2000). J Plast Reconstr Aesthet Surg. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . Collis N, McGuiness CM, Batchelor AG. Tang CL, Brown MH, Levine R, et al. Measuring health state preferences in women with breast hypertrophy. Patient demographics, surgical technique, and outcomes were analyzed. Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. Raispis T, Zehring RD, Downey DL. Schnur PL, Hoehn JG, Ilstrup DM, et al. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. 2014b;30(6):641-647. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. Li CC, Fu JP, Chang SC, et al. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. } You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. Lonie S, Sachs R, Shen A, et al. He and associates (2011) examined the safety and feasibility of vacuum-assisted biopsy device in the treatment of gynecomastia. Breast. Thus, more than 1/3of operative subjects selected for inclusion in the study did not complete it; most of the operative subjects who did not complete the study were lost to follow-up. hr.separator { Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. J Pediatr Surg. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Plast Reconstr Surg. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. In fact, according to the American Society of Plastic Surgeons, more than 46,000 breast reduction procedures were performed in 2019, a six percent increase compared to 2018; but in recent years, insurance companies have become more likely to deny coverage for this medically recommended procedure. the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Macromastia: all . display: block; Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . Statistical analysis was performed with student t-test and chi-square test. Subjects were compared to age-matched norms from another study cohort. Bland KI, Copeland EM, eds. Ages ranged from 18 to 66 years. Breast Concerns of Adolescents. Dancey A, Khan M, Dawson J, Peart F. Gigantomastia--a classification and review of the literature. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? 2016;20(3):256-260. Plastic Reconstruct Surg. } American Society of Plastic Surgeons (ASPS). Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. Fourth, insurers have provided coverage for reduction mammoplasty in women with excessively large breasts; thus, the debate is about the effectiveness of removal of smaller amounts of breast tissue from women whose breast size most persons would consider within the normal range. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. 1999;103(6):1687-1690. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. Photographs were taken pre-operatively and 1, 3, 6, and 12 months post-operatively. 1969;44(235):291-303. 2006;30(3):309-319. Plastic Reconstr Surg. Gynaecomastia. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or The authors concluded that low-dose radiotherapy to the male breast might be a safe and effective strategy to prevent gynecomastia incidence or recurrence in high-risk patients. 2001;76(5):503-510. Surg Laparosc Endosc Percutan Tech. Open surgery was performed in 56 patients, and vacuum-assisted breast biopsy was performed in 27 patients. Until now, most published research on the subject has focused on how effective surgical treatment is on correcting the cosmetic appearance of the breast. 1993;17(3):211-223. Management of gynecomastia should include evaluation, including laboratory testing, to identify underlying etiologies. Medical reduction has been achieved with agents such as dihydrotestosterone, danazol, and clomiphene. Reduction mammoplasty has been performed to relieve back and shoulder pain on the theory that reducing breast weight will relieve this pain. In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. Work-up of gynecomastia may include the following (GP Notebook, 2003): Treatment should be directed at correcting any underlying reversible causes. Seitchik (1995) reviewed the amount of breast tissue removed from a series of 100 patients that underwent breast reduction surgery. 1994;21(3):539-543. No other operation-related complications were observed. The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. CPT Codes 19316 & 19318 - Mastopexy & Reduction No significant changes have been made to the Results illustrated that 3050 patients were <60 years of age (39.7 11.8 years) and 487 were 60 years of age (65.1 4.7 years). Secondary outcomes included subjective as well as objective assessments of pain and wound healing. The American Society for Plastic Surgery (2011) advises to delay surgery until breast growth ceases: Although waiting may prolong the psychological awkwardness, it is advisable to delay surgery until breast growth ceases in order to achieve the best result. This is similar tothe American College of Obstetricians and Gynaecologists'2011 Guidelines forAdolescent Health Care chapter on breast concerns in adolescents, which states regarding breast hypertrophy: Preferably, treatment should be deferred until breast growth has been completed. Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. } Impact of surgical treatment for gynecomastia appeared to be beneficial for several psychological domains. Oxfordshire NHS Trust. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Thus, this study would not be considered of sufficient quality to provide reliable evidence of the effectiveness of a pain intervention. Clinical outcomes in reduction mammaplasty: A systemic review and meta-analysis of published studies. Copyright Aetna Inc. All rights reserved. Vacuum-assisted minimally invasive surgery-An innovative method for the operative treatment of gynecomastia. Resolution of idiopathic gynecomastia may take several months to years. Well-designed, prospective, controlled clinical studies have not been performed to assess the effectiveness of surgical removal of modest amounts of breast tissue in reducing neck, shoulder, and back pain and related disability in women. This trial included all male patients who presented to the authors breast clinic who were diagnosed with primary gynecomastia, and were treated with a trial of tamoxifen 10 mg daily therapy, over a 10-year period from October 2004 to October 2015. list-style-type: upper-roman; The operative group in the BRAVO study was drawn from a number of surgical practices that volunteered to participate in the study; no details are provided about how each center selected candidates for reduction mammoplasty, or how they chose patients who underwent mammoplasty for inclusion in the study.